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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 28th June 2017, 07:34 PM   #121
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Originally Posted by Skeptic Ginger View Post
Re dying without insurance, just found out today that one of the drugs I may need to take costs $10,000/month. Were I on Medicare (I'm not there yet) my share would be 33%, so $3,300/month for years or more.

A low income elderly person needing this drug would essentially be unable to buy it. Inadequate insurance coverage can indeed be a death sentence.
I hope you have good insurance to cover that.

Originally Posted by Emily's Cat View Post
By subsidies, I mean Medicare Savings Program, Low Income Subsidies, and a couple of others.
https://www.medicare.gov/your-medica...ing-costs.html
https://www.ehealthmedicare.com/medi...ncome-subsidy/
These programs seem to be for people under the FPL, around $1200 a month. You wouldn't have to be poor at all to find a bill like the $3300 a month SG is talking about impossible much less the 10k a month.
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Old 28th June 2017, 07:37 PM   #122
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Originally Posted by Meridian View Post
The BBC says that nine republican (at least, that's presumably what they mean) senators have said they will not support the Senate bill, but that Trump is optmisitic that they'll "get over the line". They also report a survey by USA Today saying that only 12% of Americans support the bill. (Most don't know, rather than opposing it.) I wonder what the chances of the Senate passing some version of it are!
MSNBC (or maybe it was CNN) put on a montage this evening of a gazillion Trump claims that X will happen soon/in a couple weeks/etc. none of which ever happened.
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Old 28th June 2017, 10:05 PM   #123
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Originally Posted by Skeptic Ginger View Post
Re dying without insurance, just found out today that one of the drugs I may need to take costs $10,000/month. Were I on Medicare (I'm not there yet) my share would be 33%, so $3,300/month for years or more.

A low income elderly person needing this drug would essentially be unable to buy it. Inadequate insurance coverage can indeed be a death sentence.
You might be illustrating another problem with our health-care system: Gouging by pharmaceutical companies. There's no reason why drug prices shouldn't be subject to some controls or limits. For reference, how much would that same drug cost the patient in Canada or Japan?

Also, don't most people on Medicare buy supplement or Advantage plans that include drug coverage? If you were on Medicare with the additional coverage, what would your costs be?
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Old 28th June 2017, 10:08 PM   #124
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Originally Posted by Bob001 View Post
You might be illustrating another problem with our health-care system: Gouging by pharmaceutical companies. There's no reason why drug prices shouldn't be subject to some controls or limits. For reference, how much would that same drug cost the patient in Canada or Japan?

Also, don't most people on Medicare buy supplement or Advantage plans that include drug coverage? If you were on Medicare with the additional coverage, what would your costs be?
There is no doubt that Big Pharma price gouging is out of control. But the GOP controlled Congress is overly influenced by the Big Pharma lobby.

The Democrats are not innocent in this, but they are more likely to help end this crap than the GOP is at the moment. We need to stand up to this.

As for buying supplemental insurance, I'm not in that system yet so I don't know the details. It was my doctor that told me what I would be paying for said drugs as we discussed my options.

Last edited by Skeptic Ginger; 28th June 2017 at 10:10 PM.
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Old 29th June 2017, 05:27 AM   #125
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Frogs worrying about pact with scorpion.

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One Republican congressional aide said that comment left some lawmakers worried that the president who had no real ties to the GOP before running for the White House could turn on them if a bill passes but the follow-up becomes politically damaging. The official insisted on anonymity in order to describe private discussions.
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Old 29th June 2017, 05:43 AM   #126
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With indications that the AHCA may not be passable, Mitch McConnell is contemplating a change in strategy. Fix, not repeal, ACA.
Quote:
With his bill to repeal the Affordable Care Act in deep trouble, Mitch McConnell, the Senate majority leader, raised an alternate possibility on Tuesday: Either Republicans come together, or he would have to work with Democrats to shore up the deteriorating health law. Link
Meantime in McConnell's home state, repeal of ACA could have a devastating impact. Yet many residents remain convinced, "Obamacare must go!"
Quote:
Perhaps nowhere has the health care law had as powerful an impact as in Kentucky, where nearly one in three people now receive coverage through Medicaid, expanded under the legislation. Perhaps no region in Kentucky has benefited as much as Appalachia, the impoverished eastern part of the state, where in some counties more than 60 percent of people are covered by Medicaid.

And in few places are the political complexities of health care more glaring than in this poor state with crushing medical needs, substantially alleviated by the Affordable Care Act, but where Republican opposition to the law remains almost an article of faith. Link
Reporters talked with Kentucky residents who have gained preventive healthcare, including access to a primary care physician, for the first time under ACA, yet they remain opposed to ACA, convinced it must be repealed. Yet they don't always seem aware of what it would mean to them personally. One woman suffering with lupus, who only gained healthcare coverage through ACA, was surprised to learn that under AHCA she would probably lose that coverage. She was also surprised to learn McConnell, whom she voted for, is leading the charge to roll back coverage. It's very hard to understand how someone for whom medical coverage is so important could be so totally uninformed.

It's a tough problem politically because many voters use emotion, not reason, to make their political choices. As an example, I saw a post on Facebook written by a woman who is disabled. She needs a lot of treatment and is benefiting from Medicaid expansion under ACA. Yet she is opposed to ACA -- and voted for Donald Trump -- because she calls herself pro-life and says ACA pays for abortions. She wrote she would gladly give up her Medicaid coverage in exchange for ending abortion.

Reminds me of the unemployed coal miner who said he voted for Trump, knowing he might lose his healthcare coverage, because "I'll be getting my coal mining job back."

They may only get half of what they wish for but they don't seem to really understand that.
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Old 29th June 2017, 05:46 AM   #127
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Old 29th June 2017, 06:03 AM   #128
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NPR just interviewed a senator who was talking about one of the proposed revisions lowering the proposed "uninsured" number from 21 million to 20 million.

He referred to this as a "step in the right direction".

A very small step, I imagine.

I suppose it's unfair to characterized the Republicans as heartless bastards who secretly wish the poor would simply crawl off and die... But it's getting harder not to.
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Old 29th June 2017, 06:07 AM   #129
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Originally Posted by Bikewer View Post
NPR just interviewed a senator who was talking about one of the proposed revisions lowering the proposed "uninsured" number from 21 million to 20 million.

He referred to this as a "step in the right direction".

A very small step, I imagine.

I suppose it's unfair to characterized the Republicans as heartless bastards who secretly wish the poor would simply crawl off and die... But it's getting harder not to.
It seems that each revision seems to reduce the number who would lose insurance by 1 million. It was 24, then 23, 22, 21 and so on. It's difficult to trust this kind of thing. Presumably there is a number of additional uninsured (and hence a number of additional deaths) that is acceptable to the GOP
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Old 29th June 2017, 06:28 AM   #130
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Originally Posted by Bikewer View Post
NPR just interviewed a senator who was talking about one of the proposed revisions lowering the proposed "uninsured" number from 21 million to 20 million.

He referred to this as a "step in the right direction".

A very small step, I imagine.

I suppose it's unfair to characterized the Republicans as heartless bastards who secretly wish the poor would simply crawl off and die... But it's getting harder not to.
Well Ryan has talked about his college days of dreaming about gutting medicaid. He can finally do something about it and get so many nursing homes to discharge their patients to the street.
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Old 29th June 2017, 06:48 AM   #131
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Originally Posted by Bikewer View Post
NPR just interviewed a senator who was talking about one of the proposed revisions lowering the proposed "uninsured" number from 21 million to 20 million.

He referred to this as a "step in the right direction".

A very small step, I imagine.

I suppose it's unfair to characterized the Republicans as heartless bastards who secretly wish the poor would simply crawl off and die... But it's getting harder not to.
They can leave it as is and the uninsured numbered will go down, as the uninsured start to die off.
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Old 29th June 2017, 07:13 AM   #132
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Paul Ryan will go orgasmic once the Senate passes something:
http://karireport.blogspot.com/2017/...-internet.html
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Old 29th June 2017, 07:17 AM   #133
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Originally Posted by The Don View Post
It seems that each revision seems to reduce the number who would lose insurance by 1 million. It was 24, then 23, 22, 21 and so on. It's difficult to trust this kind of thing. Presumably there is a number of additional uninsured (and hence a number of additional deaths) that is acceptable to the GOP
And based on current uninsured levels, I guess we can say that Democrats were ok with a certain number of deaths?
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Old 29th June 2017, 07:18 AM   #134
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Originally Posted by xjx388 View Post
And based on current uninsured levels, I guess we can say that Democrats were ok with a certain number of deaths?
Only if you can show that it was the Democrats who were most influential in constraining coverage and Medicare expansion and not the GOP.
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Old 29th June 2017, 07:31 AM   #135
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Originally Posted by xjx388 View Post
And based on current uninsured levels, I guess we can say that Democrats were ok with a certain number of deaths?
No, we can't say that.
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Old 29th June 2017, 11:20 AM   #136
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Note the ACA framing change today from Mnuchin:

The ACA was a tax on the economy, led to slow growth. So now the rich people are the economy.
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Old 29th June 2017, 12:09 PM   #137
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Originally Posted by xjx388 View Post
And based on current uninsured levels, I guess we can say that Democrats were ok with a certain number of deaths?
The Republicans (generally) want to make changes to the law that will result in more deaths, and they have the power to do this.

The Democrats (generally) want to make changes to the law that would result in fewer deaths, and they do not have to power to do this.

So no, you cannot say that based on the level of uninsured now. It would be the Fallacy Fallacy to say that your conclusion was false though. Everyone is 'ok' with a certain number of deaths because it's impossible to anything about a 'certain number' of deaths; it's also impossible to make a perfect system so anyone looking at it rationally is also 'ok' with a certain number of hypothetically preventable deaths. In other words, your conclusion is trivially true, as it it is true yet meaningless.

The cost/benefit for these additional deaths show the GOP and it's hanger-ons to be craven though. Additional tax cuts to the groups already doing very well that have no way to bring benefits to the public at large for thousands of additional deaths? Yes, not really another rational way to put it.
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Old 29th June 2017, 12:42 PM   #138
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Originally Posted by Marcus View Post
I hope you have good insurance to cover that.


These programs seem to be for people under the FPL, around $1200 a month. You wouldn't have to be poor at all to find a bill like the $3300 a month SG is talking about impossible much less the 10k a month.
SG's scenario leaves a lot of questions open.

Most Medicare drug coverage uses copays instead of coinsurance. PDPs are highly subsidized privatecoverage, and while it's true that there are some with coinsurance, most prefer copays because they're more palatable and attractive to people on fixed incomes. The 33% figure she has quoted seems unlikely.

Additionally, Medicare Part D has an out of pocket maximum, currently at $4950. Technically, the patient would still pay 5% above that, so it's not a true max, but very few people exceed that level.

So unless SG is giving us a scenario where the patient is paying full fare and doesn't have Part D coverage, it's exceedingly unlikely and a misleading anecdote.

Don't get me wrong - the drug costs in the US are ridiculous. But they're ridiculous enough that no exaggeration is needed in order to make that point.
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Old 29th June 2017, 01:30 PM   #139
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Originally Posted by Bikewer View Post
NPR just interviewed a senator who was talking about one of the proposed revisions lowering the proposed "uninsured" number from 21 million to 20 million.

He referred to this as a "step in the right direction".

A very small step, I imagine.

I suppose it's unfair to characterized the Republicans as heartless bastards who secretly wish the poor would simply crawl off and die... But it's getting harder not to.
As someone who has voted Republican on occasion, I sadly have to agree.
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Old 29th June 2017, 02:37 PM   #140
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Originally Posted by Emily's Cat View Post
SG's scenario leaves a lot of questions open.

Most Medicare drug coverage uses copays instead of coinsurance. PDPs are highly subsidized privatecoverage, and while it's true that there are some with coinsurance, most prefer copays because they're more palatable and attractive to people on fixed incomes. The 33% figure she has quoted seems unlikely.

Additionally, Medicare Part D has an out of pocket maximum, currently at $4950. Technically, the patient would still pay 5% above that, so it's not a true max, but very few people exceed that level.

So unless SG is giving us a scenario where the patient is paying full fare and doesn't have Part D coverage, it's exceedingly unlikely and a misleading anecdote.

Don't get me wrong - the drug costs in the US are ridiculous. But they're ridiculous enough that no exaggeration is needed in order to make that point.

If only it were so simple.

Mrs. qg is on Medicare and has a supplemental Part D policy.

She only needs two drugs to manage her COPD, a Spiriva Handihaler, and a Ventolin inhaler. (Well ... three, counting the oxygen she is hooked up to 24/7) She pretty much has to have these two drugs, or all the supplemental O2 in the world won't keep her out of the emergency room.

Our Part D plan is one of the best bang-for-the-buck plans for those two drugs I can find, using all the different insurance calculators out there.

Just looking at the Spiriva alone, over a year. Jan. is full price, just about, because of the deductible. That's right at $500. Just for one month. After that we get a stretch of months which aren't unmanageably painful, right at $100 per. For a while.

Then, around the Fall of the year, their "donut hole" kicks in. Prices jump back up to around $300 per month or more. We don't get out of the "hole" before the end of the year, when it all starts over again.

That's just for one drug, not coincidentally, I suspect, one of the most commonly prescribed drugs for her condition. COPD patients are enough of a profit target for the pharmaceutical industry that several major news organizations have done specials on the price abuse.

For some of you this may not sound all that bad, But like I said, that's just one drug. And just one of hers.

We are both on fixed incomes. I'm on disability. I can't work at all. She's on SS. She can only get out of bed with great effort. We have a little back-up in the bank, but thanks to things like this it is evaporating rapidly.

We pay 20% of every doctor's appointment, every piece of medical equipment, every everything.

Our income from SS is sufficiently high (just barely)to keep us from being eligible for any other supplemental medical assistance. We just have to get by.

I skip my doctors' appointments whenever I think I can safely do so. Just to slow down the evaporation of our meager savings. I have more doctors than she does. More meds, too.
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Last edited by quadraginta; 29th June 2017 at 02:40 PM.
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Old 29th June 2017, 03:35 PM   #141
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Originally Posted by quadraginta View Post
If only it were so simple.

Mrs. qg is on Medicare and has a supplemental Part D policy.

She only needs two drugs to manage her COPD, a Spiriva Handihaler, and a Ventolin inhaler. (Well ... three, counting the oxygen she is hooked up to 24/7) She pretty much has to have these two drugs, or all the supplemental O2 in the world won't keep her out of the emergency room.

Our Part D plan is one of the best bang-for-the-buck plans for those two drugs I can find, using all the different insurance calculators out there.

Just looking at the Spiriva alone, over a year. Jan. is full price, just about, because of the deductible. That's right at $500. Just for one month. After that we get a stretch of months which aren't unmanageably painful, right at $100 per. For a while.

Then, around the Fall of the year, their "donut hole" kicks in. Prices jump back up to around $300 per month or more. We don't get out of the "hole" before the end of the year, when it all starts over again.

That's just for one drug, not coincidentally, I suspect, one of the most commonly prescribed drugs for her condition. COPD patients are enough of a profit target for the pharmaceutical industry that several major news organizations have done specials on the price abuse.

For some of you this may not sound all that bad, But like I said, that's just one drug. And just one of hers.

We are both on fixed incomes. I'm on disability. I can't work at all. She's on SS. She can only get out of bed with great effort. We have a little back-up in the bank, but thanks to things like this it is evaporating rapidly.

We pay 20% of every doctor's appointment, every piece of medical equipment, every everything.

Our income from SS is sufficiently high (just barely)to keep us from being eligible for any other supplemental medical assistance. We just have to get by.

I skip my doctors' appointments whenever I think I can safely do so. Just to slow down the evaporation of our meager savings. I have more doctors than she does. More meds, too.
I agree that it's not simple. And while not nearly as extreme, I understand your drug-cost-pain. The donut hole is shrinking (unless congress decides to make a hash of that too), and should be closed by 2020. I know that's little comfort now, but at least it's an acknowledged problem with Part D.
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Old 29th June 2017, 03:45 PM   #142
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Originally Posted by quadraginta View Post
If only it were so simple.

Mrs. qg is on Medicare and has a supplemental Part D policy.

She only needs two drugs to manage her COPD, a Spiriva Handihaler, and a Ventolin inhaler. (Well ... three, counting the oxygen she is hooked up to 24/7) She pretty much has to have these two drugs, or all the supplemental O2 in the world won't keep her out of the emergency room.

Our Part D plan is one of the best bang-for-the-buck plans for those two drugs I can find, using all the different insurance calculators out there.

Just looking at the Spiriva alone, over a year. Jan. is full price, just about, because of the deductible. That's right at $500. Just for one month. After that we get a stretch of months which aren't unmanageably painful, right at $100 per. For a while.

Then, around the Fall of the year, their "donut hole" kicks in. Prices jump back up to around $300 per month or more. We don't get out of the "hole" before the end of the year, when it all starts over again.

That's just for one drug, not coincidentally, I suspect, one of the most commonly prescribed drugs for her condition. COPD patients are enough of a profit target for the pharmaceutical industry that several major news organizations have done specials on the price abuse.

For some of you this may not sound all that bad, But like I said, that's just one drug. And just one of hers.

We are both on fixed incomes. I'm on disability. I can't work at all. She's on SS. She can only get out of bed with great effort. We have a little back-up in the bank, but thanks to things like this it is evaporating rapidly.

We pay 20% of every doctor's appointment, every piece of medical equipment, every everything.

Our income from SS is sufficiently high (just barely)to keep us from being eligible for any other supplemental medical assistance. We just have to get by.

I skip my doctors' appointments whenever I think I can safely do so. Just to slow down the evaporation of our meager savings. I have more doctors than she does. More meds, too.
I have a 83 year old step mom who thinks she should do without her insulin when she reaches the donut hole because she can't afford it. It's been hard convincing her to accept financial help, insulin is just not optional.
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Old 29th June 2017, 06:17 PM   #143
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Originally Posted by Marcus View Post
I have a 83 year old step mom who thinks she should do without her insulin when she reaches the donut hole because she can't afford it. It's been hard convincing her to accept financial help, insulin is just not optional.
But that's the Republican plan. Living is optional. If you can't afford it, just get a job.
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Old 30th June 2017, 05:53 AM   #144
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Trump's latest Tweet:
"If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"

If there's a big enough gap, the people who die during that period will reduce the costs later.
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Old 30th June 2017, 09:44 AM   #145
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I really wish that politicians would stop trying to design health systems. They don't know anything about how it works. It's almost guaranteed to be a disaster.

You want something better? Commission the NAIC and the AAA to come up with a solution. Then stick with it.
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Old 30th June 2017, 11:00 AM   #146
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Originally Posted by Emily's Cat View Post
I really wish that politicians would stop trying to design health systems. They don't know anything about how it works. It's almost guaranteed to be a disaster.

You want something better? Commission the NAIC and the AAA to come up with a solution. Then stick with it.
Let the NAIC.....the Insurance Companies lobbying group....design a health system. That will work well.........
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Old 30th June 2017, 11:03 AM   #147
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Originally Posted by dudalb View Post
Let the NAIC.....the Insurance Companies lobbying group....design a health system. That will work well.........

If only there was some way to examine the various different alternatives in some sort of real wold situation. It's a shame no other country has ever designed a system that the US could learn from, really.
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Old 30th June 2017, 12:34 PM   #148
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Originally Posted by dudalb View Post
Let the NAIC.....the Insurance Companies lobbying group....design a health system. That will work well.........
NAIC = National Association of Insurance Commissioners. These are the regulators that oversee insurance companies. You should probably look up acronyms you're not familiar with before making assumptions. They're about as far from a lobbying group for insurance companies as you can get. These are elected officials in each state that monitor the activities of insurance companies on behalf of the citizens of that state.

The AAA is the American Academy of Actuaries. The provide ethical and practice oversight for all practicing actuaries in the US, govern the behavior of actuaries, and produce the standards of practice for that profession. Actuaries are responsible for making sure that the insurance products offered are appropriately priced and sustainable relative to the risk inherent in the pool, and that insurance companies hold sufficient reserves to meet the financial obligations of the policies they issue.

Those two organizations are pretty much the only ones with sufficient understanding of the current marketplace, the dynamics of insurance, and the impacts that changes to that marketplace (including UHC or single payer) will have. Anyone else is almost guaranteed to create as much havoc as progress.
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Old 30th June 2017, 03:10 PM   #149
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Originally Posted by Emily's Cat View Post
I really wish that politicians would stop trying to design health systems. They don't know anything about how it works. It's almost guaranteed to be a disaster.

You want something better? Commission the NAIC and the AAA to come up with a solution. Then stick with it.
When the ACA was being designed they brought in lots of experts. It hasn't been a disaster despite the Republican claims that it has.

Ever hear of the National Academy of Medicine or as it was formerly called the institute of Medicine? It's the research arm of Congress for Medical issues. Just as the National Academy of Sciences is the research arm of Congress for scientific issues.

The current Senate and House health care bills are however entirely political. They didn't ask NAM to consult on this issue. If they could, they would tell the CBO to get lost as well. These bills were never intended to improve the health care system. The goal is to give rich people a big tax break and kill Obama's signature program.
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Old 30th June 2017, 03:52 PM   #150
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Originally Posted by Emily's Cat
American Association of Actuaries, Society of Actuaries, Blue Cross Blue Shield Association Actuarial Committee. Suggestions included:
  1. increasing the penalty for mandatory coverage,
  2. changing the subsidy to be age-adjusted to reduce the dramatic cliff experienced by older consumers when they hit 400%,
  3. changing the age scale to be 5:1 instead of 3:1 to allow for lower rates for younger people,
  4. removing the minimum FPL requirement for individual market that excluded people with incomes under 133%FPL and allow for less disruptive transitioning between Medicaid and Individual markets,
  5. revisions to the risk adjustment methodology to even out the disparate preference for older/sicker individuals over younger/healthier ones and create a more stable environment,
  6. creation of an invisible high risk pool to mitigate the impact from sicker than average new entrants
and a few others I don't recall.
To take these one-by-one:

No.1 - Weren't there a lot of Republicans opposed to any penalty? That the government shouldn't be forcing people to buy a product they didn't want? But the penalty was included and was scaled to increase over time and be income-based. This is from a PBS March 2014 news report:
Quote:
In 2014, the penalty is the greater of a flat $95 per adult and $47.50 per child under age 18, up to a maximum of $285 per family, or 1 percent of your family’s modified adjusted gross income that is over the threshold the requires you to file a tax return. That threshold is $10,150 for an individual, $13,050 for a head of household and $20,300 for a married couple filing jointly.

Next year the penalty increases to $325 per adult or 2 percent of income, and in 2016 it will be the greater of $695 or 2.5 percent of income.

The $95 penalty has gotten a lot of press, but many people will be paying substantially more than that. A single person earning more than $19,650 would not qualify for the $95 penalty ($19,650 – $10,150 = $9,500 x 1% = $95). So the 1 percent penalty is the standard that will apply in most cases, say experts. For example, for a single person whose MAGI is $35,000, the penalty would be $249 ($35,000 – $10,150 = $24,850 x 1% = $249). Link
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Old 30th June 2017, 04:09 PM   #151
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Originally Posted by Emily's Cat View Post
You want something better? Commission the NAIC and the AAA to come up with a solution. Then stick with it.
And of course money is no object.
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Old 30th June 2017, 04:32 PM   #152
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Originally Posted by CapelDodger View Post
And of course money is no object.

It obviously isn't to Republicans, since the evidence is clear that their approach will end up costing the country more in the long run.

Of course, they haven't ever been interesting in saving the country money, just in making money for their wealthy backers.
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Old 30th June 2017, 10:00 PM   #153
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Originally Posted by skyeagle409 View Post
Trump's idea for making America great again is sick!
It's not actually his idea. In fact, he has no idea how it all works.
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Old 30th June 2017, 10:01 PM   #154
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Originally Posted by a_unique_person View Post
It's not actually his idea. In fact, he has no idea how it all works.
It's going to be a "surprise" to everyone.
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Old 1st July 2017, 05:06 AM   #155
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US people pay more for health care, die sooner than people in other developed countries
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Old 1st July 2017, 05:49 AM   #156
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Originally Posted by Emily's Cat
American Association of Actuaries, Society of Actuaries, Blue Cross Blue Shield Association Actuarial Committee. Suggestions included:
  1. increasing the penalty for mandatory coverage,
  2. changing the subsidy to be age-adjusted to reduce the dramatic cliff experienced by older consumers when they hit 400%,
  3. changing the age scale to be 5:1 instead of 3:1 to allow for lower rates for younger people,
  4. removing the minimum FPL requirement for individual market that excluded people with incomes under 133%FPL and allow for less disruptive transitioning between Medicaid and Individual markets,
  5. revisions to the risk adjustment methodology to even out the disparate preference for older/sicker individuals over younger/healthier ones and create a more stable environment,
  6. creation of an invisible high risk pool to mitigate the impact from sicker than average new entrants
and a few others I don't recall.
No.2, changing the subsidy to age-adjusted to avoid older consumers paying 400% of...the cost of the basic premium?

First of all what I'm seeing is the difference in costs -- between a 21-year-old and someone age 64 -- is actually about 300% or, as I find it more often expressed, 3x. This is a chart from ValuePenguin:



The ACA planners said this was done in order to allow insurers to consider age when determining premium cost. The reason for that seems obvious. However, individual states can set their own regulations. Most use the federal guidelines (above) but a few don't. New York and Vermont do not allow age to be a consideration in computing premium costs. Massachusetts does but only allows a 2x rise.

I can agree that seeing the premium cost more than double between age 40 and 60 seems extreme. I presume the thinking is, medical requirements rise with age and so does (normally) income. I would want to know the history though and without searching a news archive it is a little hard to find. What was the original proposal? Was it changed? ACA went through a long hearing process and was amended dozens of times in order to try and gain some Republican support. What was the Republican position vs. the Democrats?
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Old 1st July 2017, 07:37 AM   #157
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Originally Posted by newyorkguy View Post
No.2, changing the subsidy to age-adjusted to avoid older consumers paying 400% of...the cost of the basic premium?
ACA premium subsidies limit the cost of insurance based on family income. Limiting the annual premium of the second least expensive Silver plan to between 2% and 9% of family income for incomes between FPL and 400% of FPL respectively.

The problem is that the subsidy is eliminated when family income exceeds 400% of FPL. Without a subsidy, insurance premiums can be unaffordable (20% of income or higher) for older persons with incomes just over the subsidy cutoff. Because premiums depend on age it is seldom a problem for younger adults.

The Republican proposals adjust subsidies based on age, not income. It fixes the problem for those approaching 65 with incomes just over the current subsidy cutoff but makes insurance unaffordable for young families near the poverty line. It also ends up subsidizing wealth older Americans who can easily afford to pay the full premium.

A more reasonable solution would be to extend the subsidies past 400% of FPL. At these higher income levels the percentage of income going to insurance could also rise.
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Old 1st July 2017, 08:04 AM   #158
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FPL meaning federal poverty level. Income for a family of four at 4x the FPL would be about $98,000. Link Not having employer-based healthcare coverage is a big part of the problem. A survey done last year by the Commonwealth Fund found:
Quote:
Commonwealth also noted that higher-income Obamacare consumers are spending more on coverage, as a share of their income, than people who have job-based coverage. Link
But the message being replied to was not about income-based subsidies, it was about the way ACA lets premiums rise as one ages. Removing limits on income-based subsidies is not one of the points that was listed that actuaries recommended
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Old 1st July 2017, 08:31 AM   #159
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Yes, the ACA allows premiums to rise with age. The big complaint at the time the bill was being passed was that they didn't allow them to rise enough. The ACA limits age based premium adjustments to a 3 to 1 ratio. The actual difference in medical costs based on age is 5 to 1 or higher.
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Old 1st July 2017, 09:49 AM   #160
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Originally Posted by Kestrel View Post
The big complaint at the time the bill was being passed was that they didn't allow them to rise enough...
Complaint by whom? The post I was responding to said Congress was advised by the actuary industry that the rise was too steep. I think really to vet some of this one would have to go back and read news articles from 2009-2010.
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